Sterile clips and instrument for their placement

ABSTRACT

An improved surgical instrument and sterile clip for ligating the vessel of a mammal. The clip has a pair of legs which are urged apart by the instrument to allow the clip to be placed on the vessel to be ligated.

This is a division of application Ser. No. 07/944,584, filed Sep. 14,1992, now U.S. Pat. No. 5,342,373 which is hereby incorporated byreference.

BACKGROUND OF THE INVENTION

The present invention relates to sterile clips used to ligate vessels inmammals and more particularly to sterile clips that are used to close orshut tubular vessels such as blood vessels within the body and toinstruments for placing such clips on a vessel to ligate the vessel.

During many surgical procedures the surgeon will have to ligate or closevarious blood vessels before severing those vessels in order to preventexcessive bleeding during the surgical procedure. There are many typesof mechanisms or devices for shutting off the vessel such as ligatingclips, hemostatic clips and the like. In some instances the surgeon willtie a ligature or suture about the vessel to close or shut the vessel.Many of the clips are metal and comprise a pair of legs which areconnected at one end. The vessel to be ligated is placed between thelegs and the legs forced together about the vessel to close the vessel.Clips have also been developed from plastic materials but becauseplastics don't have the same stress and resiliency characteristics asmetals, usually the plastic clips include some type of locking mechanismso that when the legs are urged together about the vessel they arelocked in a closed position. Ligating clips are well know in the art andare disclosed in numerous U.S. Patents; as for example, U.S. Pat. Nos.3,439,523; 3,270,745; 3,363,628; 3,463,156; 3,439,522; 4,146,130;4,449,530; 4,424,810; 4,418,694; and 4,638,804.

Ligating clips must ensure closure of the vessel. That is, they shouldcompletely shut off blood flow and not allow leakage. Also, the clipsmust remain closed and should not "pop" open or break because of unduestresses. Such opening or breaking would have disastrous results duringsurgery. Furthermore, the clips should not slip or slide out of positionor off the vessel completely. While it doesn't take much force tocollapse and close a vessel, the clips, to ensure closure of that vesseland to ensure that they remain in their closed position, requiresubstantial force to close or change the configuration of the clip sothat once closed it will remain in its closed position.

With the advent of endoscopic surgery, it has become very important tosubstantially reduce the forces to carry out virtually any of themanipulations required in an endoscopic surgical procedure such asligating a vessel. In endoscopic surgery, while the business end of theinstrument is placed within the body through an appropriate cannula orsmall incision, the manipulation of that business end by the surgeon isaccomplished outside the body. As a result, it becomes more difficult tocontrol the business end of the instrument since it is further removedfrom the actual operation of the instrument and any slight movement inthe manipulation of the instrument outside the body is magnified at thebusiness end of the instrument. Therefore, the greater the forcerequired to close a clip the greater the possibility of movement of thebusiness end of the instrument and the greater the possibility that theclip is improperly placed or improperly closed.

The present invention substantially reduces the forces required toligate a vessel. The present invention also provides a clip that ensuresclosure of the vessel once the clip is placed on the vessel.Furthermore, the present invention allows for ligating clips to be madefrom many different types of materials such as metals, plastics and thelike.

Though the novel clip and instrument of the present invention is mostappropriate for use in endoscopic procedures and will be so described inthe following description it should be pointed out that the clip and/orthe instrument could also be used in laparoscopic procedures and evenstandard open type surgical procedures.

SUMMARY OF THE INVENTION

In accordance with the present invention, our new sterile clip forligating a vessel in a mammal comprises a pair of leg members. The legmembers are disposed in close proximity to one another alongsubstantially their entire length. Preferably, the leg members aresubstantially parallel to each other. The leg members are connected,preferably at one end thereof, by a member which restricts separation ofthe leg members. The connecting member should allow the open end of theleg members to be slightly pushed apart by forces applied to the openend of the leg member, but once those forces are removed the leg membersshould return to their original position.

The present invention also includes an instrument for applying thesterile clip as described above to a vessel to be ligated. Our newinstrument includes a pair of surfaces with the surfaces diverging fromeach other from their proximal end to their distal end. These surfaceswill accept a vessel to be ligated. That is, the surfaces may be placedon opposite sides of the vessel to be ligated. Once the vessel isappropriately positioned, the sterile clip as described above has itsopen end urged over the proximal end of the diverging surfaces. Thediverging surfaces spread the legs of the clip slightly and the clip isslipped over the diverging surfaces. The diverging surfaces are closedor brought to a substantially parallel position to ligate the vesselpositioned between the surfaces. Once the clip has been placed over thesurfaces with the vessel therebetween, the clips are removed from thediverging surfaces and the clip remains on the ligated vessel. Thediverging surfaces may then be removed from about the vessel.

The invention will be more fully described in conjunction with thespecific embodiments given in the following drawings and description.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of a sterile clip of the present invention;

FIG. 2 is a front view of a sterile clip of the present invention;

FIG. 3 is a perspective view of one embodiment of an instrument of thepresent invention;

FIG. 4 is an exploded isometric view of the instrument depicted in FIG.3; FIGS. 5a, b and c are a perspective view, top view and side view,respectively, of the nose or business end of an instrument according tothe present invention with the instrument in a position to accept avessel to be ligated;

FIGS. 6a, b and c are a perspective view, top view and side view,respectively, of the nose of the instrument depicted in FIG. 5 wherein asterile clip of the present invention has been placed on the vessel toligate the vessel;

FIGS. 7a, b and c are a perspective view, top view and side view,respectively, of the nose of the instrument depicted in FIG. 5 with theinstrument positioned to release the ligated vessel from the instrument;

FIG. 8 is an enlarged cross-sectional view taken along line 8--8 of FIG.5b;

FIG. 9 is an enlarged cross-sectional view taken along line 9--9 of FIG.6b;

FIG. 10 is an enlarged cross-sectional view taken along line 10--10 ofFIG. 7b;

FIG. 11 is an exploded perpective view of another embodiment on aninstrument of the present invention;

FIG. 12 is an enlarged cut-away perspective view of the drive mechanismof the instrument depicted in FIG. 11 before the instrument has beenactuated;

FIG. 13 is an enlarged perspective view of the distal end of theinstrument depicted in FIG. 11 before the instrument has been actuated;

FIG. 14 is a view similar to FIG. 12 after the instrument has beenactuated; and

FIG. 15 is a view similar to FIG. 13 after the instrument has beenactuated.

DETAILED DESCRIPTION OF THE INVENTION

Referring to the drawings in FIGS. 1 and 2, there is shown a preferredembodiment of the sterile clip of the present invention. The clip isused to ligate or close tubular vessels in a mammal and morespecifically, to close blood vessels in the body of a human duringendoscopic surgical procedures. The sterile clip 20 comprises a pair ofleg members 21 and 22. The leg members are in close proximity to oneanother along their entire length. In the embodiment, each of the legmembers is a right angle member and comprises a relatively flatlongitudinal section 23 and 24 and a perpendicular section 25 and 26extending from one edge of a longitudinal section. The perpendicularsections of the leg members face each other and are the portion of theclip which contact the vessel to ligate the vessel. The perpendicularsections are joined together at one end of the clip by a connectingmember 27 which has a cross-sectional shape similar to that of a"horse-shoe" as shown. The connecting member restricts separation of theleg members from each other. In certain embodiments of the sterile clipof the present invention, the connecting member is made of resilientmaterial so that the legs may be slightly parted to insert the alreadyclosed vessel and once inserted the leg members are allowed to return totheir original position to maintain the vessel ligated.

Ligating clips may be applied to blood vessels during a surgicalprocedure either as a single clip using a single clip applier orutilizing a multiple clip applier. The instrument may be insertedthrough a cannula during an endoscopic procedure and if a multiple clipapplier is being used the instrument may ligate or place clips on anumber of vessels. Often in a surgical procedure there is a techniquecalled ligate and divide. In this technique, an instrument is used toplace two ligating clips on the same vessel in relatively closeproximity and the surgeon either utilizing an appropriate instrument ora scalpel will cut the vessel between the two ligating clips. In FIG. 3there is shown a ligating and dividing instrument utilizing the sterileclips and instrument of the present invention. The instrument 30comprises a handle portion 31 which contains various actuating andcontrol mechanisms for the surgeon and a nose portion 32 which placesthe clips and cuts the vessel between appropriately placed clips. Thenose portion is connected to the handle portion by a magazine housing 33which is designed to fit through a cannula to allow the nose portion tobe positioned within the surgical environment and accomplish the desiredtasks.

FIG. 4 is an expanded isometric view of the various parts of theinstrument depicted in FIG. 3. The instrument comprises a handle 40 andattached to one end of the handle is a magazine housing 41. One end ofthe housing is attached to the handle while the opposite end of thehousing is the nose 42 or business end of the instrument and is designedto place clips in accordance with the present invention. The nose orbusiness end of the magazine housing contains a horizontal slot 42disposed substantially in the center of the nose and two perpendicularslots 44 and 45 disposed perpendicular and adjacent to opposite ends ofthe horizontal slot. Positioned within the magazine housing andextending from the handle to the nose is a tweezer member 46. A portionof this member grips the vessel to be ligated. One end 47 of the tweezermember is positioned within the handle so that the handle and/ormagazine housing may be reciprocated back and forth with respect to thetweezer member. The opposite end of the tweezer member fits into thehorizontal slot in the nose of the magazine. This end of the tweezermember comprises a pair of spring steel flaps 49 and 50 joined togetherat the end proximal to the handle and stressed in such a manner thatthey deflect from each other at the end distal to the handle. In theforward most position of the magazine the spring steel end of thetweezer member is aligned with the end of the nose of the magazinehousing. In the rearwardmost position of the magazine housing the springsteel end of the tweezer member extends through the horizontal slot andbeyond the nose of the magazine housing. Extending substantially thelength of the tweezer member is a slot 53. A knife member 54 ispositioned to reciprocate back and forth in this slot. The cuttingportion 55 of the knife member in its forward-most position extends tothe tip of the tweezer member and in its rearwardmost position is spaceda short distance therefrom. Also contained within the magazine housingis a clip driver 56. The driver comprises a pair of metal legs 58 and 59which extend from the handle to the nose of the magazine housing. Oneleg of the driver fits within one perpendicular slot in the nose of thehousing and the other leg of the driver fits into the otherperpendicular slot in the nose of the housing. Positioned on the frontend of the driver is a clip cartridge 60. In this embodiment there areten clips shown, five on each side aligned with a leg of the driver. Theappropriate actuating members for moving the magazine housing,positioning the clips, driving the clips and moving the knife orreciprocating the knife are provided in the handle.

The operation of the instrument will be more fully described inconjunction with FIGS. 5, 6 and 7. Referring to FIGS. 5a, b and c, thereis shown an enlarged view of the nose portion of an instrument asdescribed in conjunction with FIG. 4. FIG. 5a is a perspective view ofthe nose section, FIG. 5b is a top view and FIG. 5c is a side view. Inthese Figures, the nose portion 60 has been pushed to its rearwardmostposition. The two surfaces 61 and 62 of the tweezer portion extendbeyond the nose and diverge from each other to accept a vessel 63 to beligated. As more clearly shown in FIG. 5c, the tweezer portion extendsthrough the horizontal slot 64 in the nose portion. There also isdepicted the slot 65 in the tweezer portion which allows for movement ofthe knife. As may be seen in this position of the instrument, the clips66 are in place and positioned in the perpendicular slots 67 in the noseportion. Once the diverging surfaces of the tweezer portion are placedabout the vessel, the nose portion may be pushed forwardly. The noseportion pushed to its forwardmost position is shown in FIGS. 6a, b andc. FIG. 6a is a perspective view of the nose portion in its forwardmostposition, FIG. 6b is a top view and FIG. 6c is a side view. By movingthe magazine portion 60 forwardly, the tweezers surfaces 61 and 62 arebrought together to close the vessel 63. Simultaneously, the clips 66are moved forwardly so that the open end of a clip rides over thetweezer surfaces. At this point, the knife may be actuated to sever thevessel between the clips. The next step is to bring the magazine housing60 back to its rearwardmost or original position which is depicted inFIGS. 7a, b and c. As may be seen, the tweezer surfaces 61 and 62 extendforwardly from the nose portion and are held together by the clips 66which ride on the very outer edges of the tweezer surfaces. Once theclips are totally free from the nose of the magazine, they will drop orbe removed from the tweezer surfaces. This will allow the tweezersurfaces to open and release the ligated and divided vessel 63.

The action of the clips in closing the vessel and the release of theclips from the tweezer surfaces may be more fully understood byreferring to FIGS. 8, 9 and 10 which are enlarged cross-sectional viewsof the nose of the instrument as depicted in FIGS. 5b, 6b, and 7b,respectively. Referring to FIG. 8 the clips 70 are shown in the nose ofthe instrument in the position they have before being placed on avessel. The legs 71 and 72 of the clip are in a position where there isthe smallest gap (A) between the legs. FIG. 9 shows the nose portion ofthe instrument as shown in FIG. 6b. The nose portion is in itsforwardmost position to push the clips 70 over the tweezer surfaces 73and 74 and close a vessel. As may be seen, the tweezer surfaces tend toopen the gap (A) between the legs of the clip slightly to allow the clipto move over the tweezer surfaces. Once this is accomplished, the clipsremain on the tweezer surfaces as the magazine is brought to it rearwardnose position.

This frees the tweezer surfaces from the nose and because the tweezersurfaces are stressed to diverge from each other, they place a force onthe curve 75 between the perpendicular leg 76 and the horizontal leg 77of the clip so that the clip is removed or slides off in a sidewaysmanner from the tweezer surfaces.

Referring to FIG. 11 of the drawings, there is shown an exploded view ofanother embodiment of a clip applier instrument according to the presentinvention. In this embodiment, the instrument comprises a right handlehalf 100 and a left handle half 101. Positioned between the handlehalves is a trigger mechanism 102. The trigger mechanism is pivotallymounted on a pivot pin 103 between the handle halves. Attached at thebottom of the trigger mechanism is a drive link 104 which in turn isattached to the bottom of the drive pusher 105. Attached to the drivepusher is a first drive bar 106. As is more clearly seen in FIG. 12, atab 107 extends upwardly from the first drive bar at the proximal endthereof. This tab fits in a slot at the rear or proximal end of a seconddrive bar 108. The second drive bar sits on top of the first drive bar.Mounted on top of the second drive bar is a pivotal timing tab 109. Whenthe trigger mechanism is squeezed, the drive link forces the drivepusher forward. Both the first and second drive bars are also urgedforwardly. The first drive bar is urged forwardly by the drive pusherand the second drive bar is urged forwardly by the upstanding tab 107pushing the timing tab 109. When the timing tab moves to the end of thetiming plate 111, it is pivoted out of the way of the upstanding tab.This stops the forward motion of the second drive bar while allowing thefirst drive bar to continue its forward motion as the trigger issqueezed. On release of the trigger, a standard leaf spring mechanism(not shown for the sake of clarity) returns the trigger mechanism, drivepusher and drive bar to their original positions.

Extending from the front of the handle halves is a hollow support tube120. The first and second drive bars are disposed within the supporttube. At the distal end of the first drive bar and attached thereto is apair of spaced apart clip drivers 121 and 122. Also mounted on thehandle halves and extending down the support tube is a tweezer mechanism123. The tweezer mechanism terminates at the distal end of theinstrument in opposed grasping fingers 124 and 125 disposed between thepair of clip drivers, as is more clearly shown in FIG. 13. Attached tothe distal end of the second drive bar is the tweezer actuating means126. The means terminates at its distal end in a pair of stationaryspaced apart fingers 127 and 128 which when moved forwardly willencompass the tweezer fingers to close the fingers about a vessel placedbetween the tweezer fingers. A series of ligating clips 129 are storedin groves 130 disposed on opposite sides of the stationary fingers. Theclip drivers terminate at their distal end in abutting relationship tothe last clip in the series of clips. The clips are configured as shownin FIG. 1 with the U-shaped portion of the clip riding in the opengrooves 131 at the distal end of the twezer actuating means. TheU-shaped portion of the clip is engaged by a flexible dog 132 attachedto the clip drivers. The flexibility of the dog allows it to ride overthe next clip in the series when the clip drivers are retracted.

Referring to FIGS. 12 and 13, there is shown in FIG. 12 an enlargedcut-away view of the driving mechanism within the handle. FIG. 13 is aperspective view of the distal end of the instrument. Both Figures showthe instrument prior to the trigger being operated. As shown in FIG. 12,the upstanding tab 107 on the first drive bar 106 is positioned behindthe timing tab 109 on the second drive bar. In this position, the distalend of the instrument is as shown in FIG. 13 and a vessel 140 to beclosed is positioned betwen the tweezer fingers 124 and 125. Onsqueezing the trigger, the first drive bar moves forwardly pushing thetiming tab and the second drive bar forwardly to the position shown inFIG. 14. When the drive mechanism is in this position, the distal end ofthe instrument is as shown in FIG. 15. The second drive bar has pushedthe stationary fingers 127 and 128 over the tweezer fingers 124 and 125to close the vessel between the fingers. Simultaneously, the first drivebar has pushed the series of clips fowardly so that the first clip ineach series is immediately adjacent the vessel shown in FIG. 15.

On continuing to squeeze the trigger, the first bar urges the clips overthe vessel to close the vessel and moves the clips off the distal end ofthe clip driver tracks 121 and 122. On releasing the trigger, both drivebars and their related mechanisms return to their original positionleaving the clips on the vessel and freeing the insturment from thevessel.

An advantage of the present invention is that the clips used may moreaggressively grasp the vessel to be closed than prior art clips. Thesurface of the clips that contact the vessel to be closed may be scoredor even include dimples and the like to ensure closure and preventmovement of the clip once it is placed on the vessel.

Because less force is required to place the clip on the vessel there isreduced possibility of cutting or lacerating the vessel and greaterassurance of positive closing of the vessel throughout the surgicalprocedure.

If desired, a detent or raised portion may be disposed on the inside ofthe slots in which the clips ride or move. Such a detent is placed inline with the connecting member of the clip so that when the housing ismoved rearwardly to release the clips, the detent will crimp theconnecting member of the clip to further insure positive placement ofthe clip.

While the spring steel flaps of the tweezer member of the instrumenthave been described and shown as uninterrupted surfaces, these divergingsurfaces could comprise a plurality of fingers. By splitting orinterrupting the surface into a plurality of fingers more than two clipscould be applied at the same time.

The instrument may be made from various materials such as metals,preferably stainless steel, plastic preferably a polycarbonate resin andthe like. Usually if the instrument is made from stainless steel theinstrument will be reusable while if the instrument is made from plasticmaterials the instrument will be disposable. In certain embodiments ofthe instrument of the present invention the instrument may be designedto accept a replaceable cartridge of clips and this may be accomplishedwith either a reusable instrument or semi-disposable instrument which ismeant to be used a number of times on a single patient.

Also, while the instrument has been described for placing ligating clipsit should be appreciated that the feed member for the clips could bedisengaged and the instrument used for grasping and manipulating vesselsor tissue without ligation. Furthermore, if desired, means could beincluded with the instrument to heat the spring steel flaps so that theinstrument could also be used for caurterizing vessels or tissue.

Surprisingly, the clips of the present invention will accept varioussizes of vessels as the clip sizes itself as it is placed on the vessel.

A preferred clip of the present invention is shaped as described inconjunction with FIGS. 1 and 2. In this design the member connecting thelegs of the clip not in line with the surface of the legs which willcontact the vessel to be closed. This design allows the entire leg to beopened more or less uniformly along the entire length of the leg makingthe leg easier to part and placing less stress on the connecting member.

Another advantage of the present invention is that the clip andinstrument of the present invention may be used in smaller diametercannula than prior art clips used to close the same size vessels. Sincethe clip of the present invention is already in its closed configurationand no gripers or jaws are necessary to contact the outer surface of theclip in order to close the clip the overall diameter of the instrumentmay be reduced when compared to prior art instruments used for the samefunction. This allows the instrument to be used in smaller size cannulaand reduces the trauma to the patent.

The clips of the present invention may be made from various well-knownmaterials, for example, titanium, tantalum, stainless steel, the memorymetals having super elastic characteristics and the like or the variousplastic materials that have some resiliency such as the polyolefins, theglycolide-lactide polymers and similar plastic materials.

Having now described the present invention, it will be readily apparentto those skilled in the art that various modifications and alterationsmay be made to the present invention without departing from the spiritand scope thereof.

What is claimed is:
 1. A method of applying a sterile tissue fastener totissue to be occluded comprising:providing a fastener applyinginstrument containing a tissue fastener, said instrument having anactuating end coupled by a tubular shaft to an applying end saidapplying end including diverging surfaces; positioning tissue to beoccluded between diverging surfaces of said fastener applyinginstrument; applying a compressing force to said tissue using saiddiverging surfaces; moving said fastener toward the distal end of saiddiverging surfaces; moving said fastener over a portion of said tissuethat is at least partially compressed by the applied compressing forceof the diverging surfaces and disassociating said fastener from theinstrument; and removing said diverging surfaces from the tissue wherebysaid fastener occludes said portion of said tissue.
 2. The method ofclaim 1 wherein the diverging surfaces are placed on opposite sides ofthe tissue to be occluded.
 3. The method of claim 1 wherein thediverging surfaces are brought to a substantially parallel position toocclude the tissue placed between the surfaces.
 4. The method of claim 1wherein said fastener is moved from a closed position to an openposition to provide an opening for capturing tissue prior todisassociating said fastener from the instrument.
 5. The method of claim4 wherein the fastener is moved from its closed position to its openposition as the fastener is moved towards the distal end of thediverging surfaces and wherein said diverging surfaces maintain thefastener in its open position until it is placed over tissue to beoccluded.
 6. The method of claim 4 wherein the fastener closes towardsits closed position as said fastener is disassociated from theinstrument, whereby the fastener provides a compressing force tomaintain sufficient tissue occlusion provided by the diverging surfaceswhen said diverging surfaces are removed.
 7. The method of claim 1wherein said fastener comprises a clip having leg members in closeproximity to one another, whereby leg members are spread from oneanother when the clip is moved towards the distal end of the divergingsurfaces and said clip closes over the tissue when disassociated fromthe fastener applying instrument.
 8. The method of claim 7 wherein saidleg members are substantially parallel along at least a portion of theirlength when said fastener is closed.
 9. The method of claim 7 wherein atleast one diverging surface spreads the leg members slightly from oneanother to move said clip from a closed position to an open position toprovide the opening for capturing tissue.
 10. The method of claim 1wherein said fastener is used to occlude tissue during an endoscopicprocedure.
 11. An endoscopic instrument for applying occlusion fastenerscomprising:a fastener having open and closed positions; an actuating endand an applying end, said ends being connected by a hollow, tubularshaft; means included with the instrument for feeding occlusionfasteners to the applying end of the instrument while the fasteners arein a closed position; and means coupled to said shaft, for engaging andcompressing tissue to provide occlusion thereof, prior to applying saidfastener to the tissue.
 12. The endoscopic instrument of claim 11further comprising means for opening the fastener at the applying end ofsaid instrument to provide an opening sufficient to capture tissue to beoccluded.
 13. The endoscopic instrument of claim 12 further comprisingmeans associated with said applying end, for disassociating the fastenerfrom said instrument.
 14. The endoscopic instrument of claim 11 whereinsaid means for engaging and compressing comprises diverging surfacespositioned at the applying end of said instrument.
 15. In combination,an endoscopic fastener applying instrument and surgical fastenercomprising:a surgical fastener adapted to occlude tissue; saidinstrument including an actuating end and an applying end, said endsbeing connected by a hollow, tubular shaft; means included with saidinstrument for feeding said fastener to the applying end of theinstrument while said fastener is in a closed position; means foropening the fastener at the applying end of said instrument to providean opening sufficient to capture tissue to be occluded; and wherein saidmeans for engaging and compressing tissue includes:diverging surfacespositioned at the applying end; a reciprocal member disposed at thedistal end of said hollow tubular portion, said reciprocal membercapable of engaging and moving at least one of said diverging surfacesto cause diverging surfaces to compress tissue therebetween; and a firstdrive means extending from said actuating means to said reciprocalmember to move said reciprocal member and cause said diverging surfacesto compress tissue.
 16. The endoscopic fastener applying instrument andsurgical fastener of claim 15 wherein said instrument further comprisesmeans to return said reciprocal member to its original position andremove said diverging surfaces from the occluded tissue.
 17. Incombination, an endoscopic fastener applying instrument and surgicalfastening means comprisinga surgical fastener for occluding tissue; saidinstrument including an actuating end and an applying end, said endsbeing connected by a hollow, tubular shaft; means included with saidinstrument for feeding said fastener to the applying end of theinstrument while said fastener is in a closed position; means foropening the fastener at the applying end of said instrument to providean opening sufficient to capture tissue to be occluded; wherein saidsurgical fastener comprises a plurality of clips in seriatim disposed insaid instrument; and wherein said means for feeding said fastener to theapplying end includes a drive means extending from said actuating end tothe proximal clip of said plurality of clips to move said plurality ofclips and to move the most distal clip along said diverging surfaceswhen said diverging surfaces are compressing tissue, to place said clipon the tissue.
 18. In combination, an endoscopic fastener applyinginstrument and surgical fastener comprising:a surgical fastener foroccluding tissue, said fastener having an open position and a closedposition, wherein said fastener is biased towards said closed position;said instrument including an actuating end and an applying end, saidends being connected by a hollow, tubular shaft; means included withsaid instrument for feeding said fastener to the applying end of theinstrument while said fastener is in the closed position; means foropening the fastener at the applying end of said instrument to the openposition to provide an opening sufficient to capture tissue to beoccluded; and means at said applying end of the instrument fordisassociating the fastener from said instrument, wherein said fasteneris adapted to move itself from said open position towards the closedposition as said fastener is disassociated from said instrument wherebysaid fastener provides sufficient compression to maintain occlusion ofcaptured tissue.
 19. In combination, an endoscopic fastener applyinginstrument and surgical fastener comprising:a surgical fastener foroccluding tissue; said instrument including an actuating end and anapplying end, said ends being connected by a hollow, tubular shaft;means included with said instrument for feeding said fastener to theapplying end of the instrument while said fastener is in a closedposition; and means for engaging and compressing tissue to occlude saidtissue before applying said fastener to said tissue, said engaging andcompressing means positioned at said applying end.
 20. The endoscopicfastener applying instrument and surgical fastener of claim 19 whereinsaid means for engaging and compressing tissue includes:divergingsurfaces positioned at the applying end; a reciprocal member disposed atthe distal end of said hollow tubular portion, said reciprocal membercapable of engaging and moving at least one of said diverging surfacesto cause diverging surfaces to compress tissue therebetween; and a firstdrive means extending from said actuating means to said reciprocalmember to move said reciprocal member and cause said diverging surfacesto compress tissue.
 21. The endoscopic fastener applying instrument andsurgical fastener of claim 20 wherein said instrument further comprisesmeans to return said reciprocal member to its original position andremove said diverging surfaces from the occluded tissue.
 22. Theendoscopic fastener applying instrument and surgical fastener of claim19 wherein said surgical fastener comprises a plurality of clips inseriatim disposed in said instrument.
 23. The endoscopic fastenerapplying instrument and surgical fastener of claim 22 wherein said meansfor feeding said fastener to the applying end includes a drive meansextending from said actuating means to the proximal clip of saidplurality of clips to move said plurality of clips and to move the mostdistal clip along said diverging surfaces when said diverging surfacesare compressing tissue, to place said clip on the tissue.
 24. Theendoscopic fastener applying instrument and surgical fastener of claim19 further comprising:means for opening the fastener at the applying endof said instrument to provide an opening sufficient to capture tissue tobe occluded.